Individual
DR. MARK D DENNEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1340 S AMMON RD, AMMON, ID 83406-5810
(208) 523-3141
(208) 525-2661
Mailing address
1340 S AMMON RD, AMMON, ID 83406-5810
(208) 523-3141
(208) 525-2661
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODP1012
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010026621
BLUE SHIELD
ID
01
—
167539
COLE
ID
05
—
805561900
—
ID
01
—
V3918
BLUE CROSS
ID
Enumeration date
01/02/2007
Last updated
06/02/2010
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